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1 Mental Health and Law Enforcement Encounters: A Review of Current Problem and Recommendations Prepared by the Georgia Association of Chiefs of Police Mental Health Ad Hoc Committee to Address Mental Health Issues in Law Enforcement

4 ACKNOWLEDGEMENTS This paper was written by Captain Eric Gattiker with input and direction by all those committed to serve on the Georgia Association of Chiefs of Police Mental Health Ad Hoc Committee. Special thanks go out to Captain Jonathan Blackmon of the State Hospital Police Department and Director Kenneth Bramlett of the Department of Human Resources who have offered to become points of contact for law enforcement in the field. Special thanks is deserving of Dr. Donald Manning of the Department of Human Resources for taking time out of his busy schedule to meet with and share information critical to the committee. 4

5 PREFACE In recent years, Georgia law enforcement officers have experienced an increase in the number encounters with persons who have mental health issues. Because of limited access to mental health services, law enforcement officials often witness individuals behavior degenerate into criminal violations that require an arrest to be made. These behaviors have manifested themselves in a variety of behaviors including domestic disturbances, assaults, alcohol/drug violations, and homicides. As a result, many of these persons have been funneled into the criminal justice system and incarcerated in municipal, county, and state detention and correctional facilities for behavior that could have been prevented if the individual had access to adequate mental health services. In some cases, officers have been required to use physical force to affect an arrest of these individuals. Unfortunately, in some instances officers have been forced to use deadly force to defend themselves. These dangerous encounters are a threat to the police, mental health consumers, and public. In addition, these instances are emotionally challenging for officers and require they face lengthy investigations, scrutiny, and criticism. In an effort to address these issues, the Georgia Association of Chiefs of Police authorized an Ad Hoc Committee to study the impact of persons with mental health issues on Georgia law enforcement agencies. The Committee was asked to review and report on the: Magnitude the of the problem; Problems within the system; Contributing factors; Recommend potential solutions/action items along with needed legislation; Model policy recommendations; and Training for command and line staff. Public Safety Director Dwayne Orrick City of Cordele 2007 / 2008 GACP President 5

6 INTRODUCTION The National Institute of Mental Health estimates that about 1 in 4 adults over the age of 18 suffer from some form of a diagnosable mental disorder. 1 In addition, approximately 6% of the population in the United States suffers from a serious mental illness. 2 Health care is expensive, and not everyone can afford treatment or is not covered by an insurance plan to assist in offsetting the costs. Individuals who go without the necessary care often find themselves routed through the criminal justice system where local jails and state prisons become the primary caregiver to many with a mental illness. In Georgia, 16% of prison inmates suffer from mental illness. 3 Between 1999 and 2006, the number of Georgia Department of Corrections inmates receiving care for mental illness increased by 73%. 4 Mental Illness impacts every class and every community. A recent report compiled at the University of Georgia reports that between May 2006 and May 2007, Counseling and Psychiatric Services (CAPS) provided 17,357 student contacts to include phone contacts, clinical telephone and in-person contacts, and contacts with others on behalf of students. 5 While not all of these contacts were for serious mental disorders, figures captured by CAPS are significant in that 334 students reported having thoughts of suicide and 13 students reported thoughts of wanting to harm others. 6 Such thoughts must be taken seriously and addressed, especially in light of violence seen on both secondary and postsecondary campuses. It is not known whether the increase in inmates being treated for mental illness is due to an actual increase in incidence of mental illness or to better identification. Regardless, the massive influx of prisoners into state penal institutions, the decrease in state psychiatric hospital beds and the Department of Human Resources policy that state psychiatric hospital care is the least intrusive option for the individual has forced many in need of care to remain incarcerated or be released back onto the street with only a limited supply of medication. As a result, law enforcement officers are increasingly in contact with the mentally ill. The Criminal Justice / Mental Health Consensus Project cites the following statistical information regarding police contacts and the mentally ill. In the police departments of U.S. cities with a population greater than 100,000, approximately 7 percent of all police contacts, both investigations and complaints, involve a person believed to have a mental illness. Of 331 people with severe mental disorders who were hospitalized, 20 percent reported being arrested or picked up by police for a crime some time in the four months prior to their hospital admission most commonly for alcohol, drug, or public disorder crimes. 6

7 A study of a special unit of a major metropolitan police department mandated to respond to incidents involving emotionally disturbed persons estimated that 5 percent of the dispatches per year involve a person with a mental illness. During the year 2000, law enforcement officers in Florida transported more than 40,000 people with mental illness for involuntary 72 hour psychiatric examinations. 7 Law enforcement officers in Georgia routinely encounter persons who show signs of mental illness. The problem is that state and local resources are overtaxed resulting in little to no options available to law enforcement for a meaningful disposition of such encounters. Lack of officer training, lack of available resources or not knowing what resources are available often force an officer to arrest when other treatment is needed. The Georgia Association of Chiefs of Police (GACP) realizes encounters with the mentally ill are reoccurring and the need exists to direct the mentally ill to the appropriate care. The GACP created the Mental Health Ad Hoc Committee in the summer of Initially, the goal of the committee was to address a broad range of mental health issues facing law enforcement in Georgia. However, events evolved while work on this committee was being undertaken that required the committee to refocus and further define its purpose. At the present time, problems with the mental health system are receiving needed attention by state officials, legislators and the Governor. For example, HB 535 passed the House and Senate and is awaiting the Governor s signature. HB 535 will establish an ombudsman who will ensure, among other duties, that standards are met within state psychiatric hospitals. Other commissions or task forces currently addressing mental health have been identified. The Department of Human Resources, responsible for providing state care, enacted policies that should address the issues many law enforcement agencies face when dealing with the mentally ill in their communities. It is the goal of the GACP Mental Health Ad Hoc Committee to address issues facing law enforcement through recommendations and in identifying available resources that will assist in daily activities. By recognizing the importance of actions taken by other entities in addressing mental health concerns, the GACP Mental Health Ad Hoc Committee has narrowed its original focus so as not to duplicate but to support important work that is already underway. The complexity of mental health affects all walks of life and cannot be simplified into a one size fits all solution. Hopefully the work of the GACP Mental Health Ad Hoc Committee will be one step toward current and a continued process that assists not only law enforcement needs but the needs of the patients who are the unfortunate victims. PROBLEMS The GACP Mental Health Ad Hoc Committee was established in response to a wide range of problems observed by the Georgia Association of Chiefs of Police. Problems as reported by police chiefs from across the state include: 7

8 Severe inconsistency in how mental health cases are handled throughout the state. It varies greatly from jurisdiction to jurisdiction. Extraordinarily long times being spent by law enforcement having patients committed and transported to emergency receiving facilities or approved treatment centers. Refusal of mental health providers to accept patients at all or without law enforcement being required to stay with them until an examination is completed. Law Enforcement is told they must stay at the facility, against their will, until the examination concludes. Patients are constantly being returned to the community without any meaningful disposition being made in their case. A revolving door so to speak, with the community and the patient suffering the consequences of this failure as a result. This non treatment posture has resulted in the death of patients. Lack of a statutory requirement or refusal to comply with existing statutory requirements on how patients are to be admitted for treatment. A need exists for a quality standard admittance procedure that is followed state wide. No money to support mental treatment locally. Lack of political support for dealing with the mental health system and its problems. Mental health patients becoming wards of the criminal justice system due to the fact that mental health systems cannot or will not provide treatment or care for these patients. While these patients may have violated the laws of the state, they are becoming members of a secondary mental health system which are the county jails and state prison system. Recognizing this issue is not isolated strictly to police and that overlap exists between both police and sheriff s department interactions, it was determined that representation would be needed from sheriff s departments to gain a more encompassing law enforcement perspective on this issue. To add to the problems already mentioned, additional problems as seen by Georgia sheriff s departments include: Lack of suitable placement of the mentally ill or suicidal inmates that are scheduled for release. Inmates with no formal charges against them often have to be released back into the community. Unfortunate instances exist whereby a released inmate attempts to overtake a civilian staff member outside the facility or steps out into traffic and is stuck by an oncoming vehicle. If the regional hospital servicing a particular county is out of bed space, a patient with a 1013 will need to be transported to another receiving hospital. Two deputies may spend an entire shift on patient transport and placement. Inmates incompetent to stand trial and who are remanded to the custody of the Georgia Department of Human Resources remain in jail due to lack of bed space. Average length of stay at one county jail is 5 months. The sheriff s department becomes the primary mental health care provider. 8

9 CONCURRENT INITIATIVES Two other initiatives are currently ongoing in the State of Georgia that address the important issues associated with mental health. The first is the Mental Health Service Delivery Commission, created by executive order issued by Governor Sonny Perdue. According to the Executive Order, the commission shall make a report to the General Assembly and the Office of the Governor on or before June 2, 2008, as to the progress of the Commission in identifying the challenges in the State s deliverance of mental health services; developing an organizational plan for coordinating the State s various systems and the financial and staffing needs of these systems to assure a safe and secure system of services; and anticipated and proposed implementation of action. 8 Publicized issues that are to be addressed by the commission include perceived or actual lack of sufficient funding, inadequate staffing and service delivery systems, overcrowding, treatment practices that unnecessarily separate consumers from their families, and the need for ongoing and effective advocacy on behalf of those children and adults living and receiving behavioral health services. 9 The second initiative is the Chief Justice-Led Task Force to Promote Criminal Justice / Mental Health Collaboration. This grant money supported task force, coordinated through the Judge s Criminal Justice / Mental Health Leadership Initiative, selected Georgia as one of only a few states to establish statewide teams to address criminal justice / mental health issues. Chief Justice Leah Ward Sears charged the task force to review the systemic problems that cause people with mental illness to be arrested and incarcerated in disproportionate numbers and to identify solutions to these problems. 10 RECOMMENDATIONS OF COMMITTEE LEGISLATION Propose legislation that would require mandatory reporting by mental health professionals when patient expresses feelings or thoughts of harming others or in committing actions opposed to public safety. Propose legislation that allows law enforcement to obtain mental health records. Committals, both voluntary and involuntary, should be available for review. Process would be similar to that of criminal history information, whereby history information can be obtained as necessary for the investigation of criminal or suspected criminal activity. Understanding both the Health Insurance Portability and Accountability Act (HIPAA) and Family Education Rights and Privacy Act (FERPA) establish rules regarding dissemination of such information; the GACP Mental Health Ad Hoc Committee feels a study group may be necessary to research federal restrictions to any future proposed legislation. POLICY 9

10 Require Georgia law enforcement agencies to have in place a policy when interacting with mentally ill persons. Sample policy can be included and distributed by the GACP and maintained on the GACP web page (see Resource Guide). INTAKE SCREENING Create consistency in the mental illness screening process used by jail intake across the state. Many jails do screen for mental illness, but the screening processes vary. A uniform screening process with proven validity is needed to ensure persons incarcerated receive the needed mental health care (see Resource Guide). MENTAL HEALTH COURTS With only six mental health courts in the state to address nuisance crimes committed by persons with a mental illness, work needs to continue in partnership with the Administrative Office of the Courts to promote further expansion of these courts into all geographical locations of the state. An application has been submitted by the Administrative Office of the Courts to receive funds under the BJA Justice and Mental Health Collaboration Program. Funding, if approved, will establish an additional Mental Health Court serving Georgia Judicial District 9. The GACP must continue and support this and future initiatives aimed at diverting the mentally ill from state correctional facilities and county jails. Mental Health Courts have proven to be a successful alternative to incarceration and diverts offenders to available resources. TRAINING At the present time, Crisis Intervention Training (CIT) is offered as a 40 hour course approved by the Georgia Peace Officer Standards and Training Council. Statistics have shown that police encounters with the mentally ill occur frequently and that incarceration is not always the best solution in handling encounters with the mentally ill. It is incumbent that all officers understand signs of mental illness, how to proceed with an encounter and be familiar with available state and local resources. The GACP Mental Health Ad Hoc Committee recommends CIT training shifts as a volunteer course to mandated academy training (See Resource Guide). LAW ENFORCEMENT / MENTAL HEALTH COMMITTEE Create an ongoing committee with representation from professional law enforcement organizations, to include the Georgia Association of Chiefs of Police, the Georgia Sheriff s Association and the Georgia Department of Human Resources. Regularly scheduled meetings build relationships between agencies that are important in addressing issues as they arise. A committee allows for a team approach in solving problems. Representatives can be familiarized with incidents experienced by law enforcement officer s interactions with mentally ill citizens in their communities. Incidents involving possible breaches of policy or the need for additional policy can be investigated further. Meetings will also allow for information exchange which helps lead to a more successful 10

11 resolution of future incidents and in building professional relationships with others who may assist with certain problems as they are encountered. Based on discussions that took place on the GACP Mental Health Ad Hoc Committee, problems being experienced were not known across disciplines. A joint approach in problem solving is needed when addressing a complex issue. ONLINE COMPLAINT PROCESS Work with the Georgia Department of Human Resources in establishing an online complaint mechanism. Occurrences involving inefficiencies in the placement of mentally ill who are in law enforcement custody can be forwarded to DHR for review and feedback. CONCLUSION Problems experienced by Georgia law enforcement obviously are the result of a much larger issue. Georgia s population has increased by 51% since However, the state prison population has increased by 209% in roughly the same time period. 12 With more and more of the incarcerated exhibiting signs of mental illness, many of the less serious offenders are cycled back onto the street due to a lack of resources. State hospitals have limited bed space and cannot accommodate all in need of treatment. The result is and will continue to be an increase in police, mentally ill encounters on the street. During the past year, increased attention has been placed on mental health services, procedures and oversight. With this increased attention, state law enforcement will have a greater impact supporting existing publicized initiatives rather than focusing solely on addressing problems experienced by front line officers. Actions to include the creation of standardized hospital admittance policies, the creation of additional mental health courts and specialized training are positive indicators that various organizations are working hard to better assist Georgia citizens who have a mental illness. While not all of the current initiatives focus directly at law enforcement, law enforcement will benefit equally the same. The GACP Mental Health Ad Hoc Committee to Address Mental Health Issues in Law Enforcement believes the committee s efforts in identifying issues facing law enforcement, identifying recommendations and in providing current available resources, found in this paper s resource section, are equally important and reinforces the benefits of multiple disciplines joining together for a common goal. 1 The Numbers Count: Mental Disorders in America. National Institute of Mental Health, 2 Ibid 3 Minutes from the Chief Justice-Led Task Force to Promote Criminal Justice / Mental Health Collaboration, June 26, Simmons, Andria, Prisons See More Inmates Requiring Mental Health Care, Gwinnettdaily post.com, July 20, Evaluation of Psychological Services Protocols, Committee Report, September 2007, 6 Ibid 11

15 PURPOSE During committee work of the Georgia Association of Chiefs of Police Mental Health Ad Hoc Committee, resources were identified that addressed many of the problems initially identified and tabled for discussion. Many of the problems were identified by law enforcement officers in the field who had first hand experience of apparent breakdowns in the system. Some of the breakdowns resulted from not being fully aware of services available in the community for law enforcement to utilize. The purpose of establishing a resource guide is to make information available that can be used immediately, as in the Behavioral Health Link, which will offer law enforcement officers a viable solution in getting the mentally ill services they need. It is the Georgia Chiefs Mental Health Ad Hoc Committee s hope that the information outlined in this guide will be of assistance to law enforcement and will enable them to have more productive interactions with the mentally ill, regardless as to whether a criminal violation exists. The public servants committed to the Georgia Chiefs Mental Health Ad Hoc Committee should also be looked upon as resources themselves. Two of the committee members, Kenneth Bramlett and Jonathan Blackmon, have communicated their dedication in resolving problems experienced by law enforcement officers that occur at DHR state hospitals. 1. If a law enforcement officer has first hand knowledge of Department of Human Resources refusal to take custody of a person when required to by law, contact Director Kenneth Bramlett at the following information: Georgia Department of Human Resources 2 Peachtree Street, NW Suite Atlanta, GA If the Department of Human Resources is required to take custody of a person when required to by law, and refuses to allow the transporting law enforcement officer to leave the facility for any reason, contact Captain Jonathan Blackmon at the following information: Northwest Georgia Regional Hospital State Hospital Department 1305 Redmond Circle Rome, Georgia (office) (Cell) R-3

16 SAMPLE POLICY IN HANDLING THE MENTALLY ILL MANAGING MENTALLY ILL PERSONS PURPOSE: POLICY: DEFINITIONS: The purpose of this policy is to establish guidelines and procedures for law enforcement personnel in the recognition and safe handling of suspected mentally ill persons. Agency personnel will afford people who have mental illnesses the same rights, dignity and access to police and other government and community services that are provided to all citizens. It is the policy of law enforcement personnel to manage suspected mentally ill persons in a safe, effective and efficient manner. EXCITED DELIRIUM: A state of extreme mental and physiological excitement, characterized by extreme agitation and hyperactivity, overheating, excessive tearing of the eyes, hostility, superhuman strength, aggression, acute paranoia, and endurance without apparent fatigue. Due to this being considered a serious medical emergency, persons in this state of mind shall be transported to the hospital by a med unit for medical evaluation. MENTAL ILLNESS: Any of various conditions characterized by impairment of an individual s normal cognitive, emotional, or behavior functioning, and caused by social, psychological, biochemical, genetic, or other factors, such as infection or head trauma. PROCEDURES: A. Recognition of Mental Illness Indicators that a person may be suffering from mental illness include Verbal, Behavioral and Environmental Cues. When making observations of the following cues, personnel should: 1. Note as many indicators as possible; 2. Put the indicators into the context of the situation; 3. Be mindful of environmental and cultural factors. Verbal Cues these may include: a. Illogical thoughts 1. Expressing a combination of unrelated or abstract topics. 2. Expressing thoughts of greatness, e.g., person believes he is GOD. R-4

18 f. Causing injury to self e.g., cutting self with sharp objects, cigarette burns on body, starving self. g. Nonverbal expressions of sadness or grief. h. Inappropriate emotional reactions. 1. Overreacting to situations in a overly angry or frightening way. 2. Reacting with opposite of expected emotion e.g., laughing at an auto accident. Environmental Cues Inappropriate surroundings: a. Decorations 1. Strange trimmings, inappropriate use of household items, e.g., aluminum foil covering windows. b. Waste matter/trash 1. Packratting accumulation of trash, e.g., hording string, newspapers, paper bags, clutter, etc. 2. Presence of feces or urine on the floor or walls. c. Childish objects B. INTERACTING WITH A PERSON WITH MENTAL ILLNESS Officers on the scene shall make every effort to determine the severity of the behavior, the potential for change in the behavior, and the potential for danger presented by the individual to themselves the officers, and/or others. The following guidelines detail how to approach and interact with a person who may have mental illness and who may be a crime victim, witness or suspect. These guidelines shall be followed in all contacts, whether on the street or during more formal interview and interrogations. Officers, while protecting their own safety, the safety of the person with mental illness and others at the scene shall: 1. Remember the mentally ill person in a crisis situation is generally afraid; 2. Continually assess the situation for an escalation of risk to all parties; 3. Maintain appropriate distance between you and the person; 4. Attempt to remain calm and avoid overreacting; 5. Give clear/concise directions. The person probably already confused and may have trouble making even the simplest decision. Ideally, only one person should attempt to communicate with the person; R-6

19 6. Respond to apparent feelings, rather than content (i.e., You look/sound scared. ); 7. Respond to delusions and hallucinations by addressing the person s feelings rather than what he is saying (i.e., That sounds frightening, I can see why you are angry. ); 8. Try to help. People, generally will respond to questions concerning their basic needs (e.g., safety). What would make you feel safer/calmer, etc.? ; 9. Move slowly; 10. Remove distractions, upsetting influence and disruptive people from the scene; 11. Obtain on-scene medical aid when treatment of an injury is needed, or suicidal thoughts are made; 12. Be friendly, patient, accepting and encouraging, but remain firm and professional; 13. Be aware that the uniform, gun, handcuffs, etc., may frighten the person with mental illness, attempt to reassure him/her that no harm is intended; 14. Gather information from family or bystanders. While each incident will be different, when dealing with a person who may have mental illness, personnel should be aware their actins may have an adverse effect on the situation. Actions that officers should generally avoid include: 1. Moving suddenly, giving rapid orders or shouting; 2. Join into behavior related to the person s mental illness (e.g., agreeing/disagreeing with delusions/hallucinations); 3. Stare at the person; this may be interpreted as a threat; 4. Crowding the person or moving into his/her zone of comfort; 5. Give multiple choices Giving multiple choices increases the person s confusion; 6. Whisper, joke or laugh Increases the person s suspiciousness with potential for violence; 7. Expressing anger, impatience or irritation; 8. Assuming that a person who does not respond cannot hear; 9. Using inflammatory language, such as mental or mental subject; 10. Deceiving the subject, being dishonest increases fear and suspicion; 11. Minimize concerns (i.e., Oh things that can t be that bad, etc); R-7

20 12. Touch the person (unless essential for safety) Although touching can be helpful to some people who are upset, for many it may cause more fear and lead to violence. C. PROCEDURES FOR ACCESSING COMMUNITY MENTAL HEALTH RESOURCES Once sufficient information has been collected about the nature of the situation, and the situation has been stabilized, the officer has several options to consider when selecting an appropriate disposition. 1. If there is evidence of a medical problem or injury, appropriate Emergency Medical Services shall be requested to check the individual, prior to release, referral or transporting. 2. If there is no evident medical problem or injury, the officer may refer the family or care giver to: a. Their local medical and mental health facilities 3. Based upon and having in possession a valid physician certificate Emergency Admission Certificate and Report of Peace Officer also known as a 1013 form take the individual into custody and deliver the person named in the certificate to the nearest available emergency receiving facility. Any peace officer taking into custody and delivering for examination a person, as authorized by OCGA , shall execute a written report detailing the circumstances under which such person was taken into custody. The report and either the physician s certificate or court order authorizing such taking into custody shall be made a part of the patient s clinical record. As per Georgia Code Section Any peace officer may take any person to a physician or directly to an emergency receiving facility for an examination, if the person is committing a penal offense and the officer has probable cause for believing that the person is mentally ill and in need of involuntary treatment. The officer need not formally tender charges against the individual before taking them in for an examination (OCGA (a). Whenever a person is taken into custody for the purpose of transport to a physician or an emergency receiving facility for an examination, the officer must complete a Departmental Incident Report detailing the circumstances under which such a person was taken into custody (OCGA ; ). B. EXCITED DELIRIUM Per OCGA it shall be the responsibility of the governing authority of the county of the patient s residence to arrange transportation from one facility to another facility. Indicators that a person may be suffering from excited delirium include: 1. Bizarre or violent behavior; 2. Signs of overheating/profuse sweating; 3. Only partially clothed or naked; R-8

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